OITE & ABOS Orthopedic Exam Prep: Trauma, Shoulder & Tendon MCQs | Part 164

A 21-year-old woman has a nontraumatic rupture of the Achilles tendon. Which of the following commonly prescribed medications has been associated with this condition?

Figures 45a and 45b show the radiographs of a 40-year-old woman with rheumatoid arthritis who is unable to straighten her ring and little fingers. Examination reveals that the fingers can be passively corrected, but she is unable to actively maintain the fingers in extension. Management should consist of

A 34-year-old man underwent open reduction and internal fixation of a closed both bones forearm fracture 11 months ago. The radiographs shown in Figures 32a and 32b reveal a 3-mm gap and loose screws. What is the best treatment option?

An investigation studying whether physical therapy or subacromial injection can be successfully used to treat shoulder pain is conducted. Two groups are identified. One group is prescribed physical therapy, while the other receives a subacromial injection. The groups have similar baseline demographics and shoulder pathologies. Ten patients are randomized in each group and findings show that there is no significant difference in any patient-reported outcome measure. An increase in sample size would reduce the risk of what parameter?

Which of the following is an FDA approved adjunctive treatment for an acute open tibia fracture being treated with an intramedullary nail?

An 18-year-old lacrosse player is diagnosed with infectious mononucleosis. What is the recommendation for return to play? Review Topic

A 24-year-old former high school wrestler had anterior cruciate ligament (ACL) reconstruction with hamstring autograft 6 years ago. He now experiences daily instability of his knee with routine activities including walking. Examination reveals a grade 3+ Lachman test with a soft endpoint, varus laxity at 30°, and a positive dial test at 30° that dissipates at 90° of knee flexion. He has mild medial joint line tenderness. When walking, there is a slight varus thrust. What treatment is most likely to lead to a successful outcome?

What is the most common arthroscopic finding of internal impingement in an overhead athlete?

A 77-year-old man with a history of mild renal insufficiency and atrial fibrillation on warfarin therapy is scheduled to undergo a left total hip arthroplasty. He previously underwent a right total hip arthroplasty with development of significant heterotopic bone that resulted in limitation of motion. What is the most appropriate form of prophylactic treatment to minimize the formation of heterotopic bone on his left hip?

A 21-year-old collegiate wrestler sustains a blow to his right eye during a match. Examination reveals anisocoria with a dilated right pupil. The globe is properly formed, and extra-occular movements and the visual field are grossly intact. What is the most likely diagnosis?

• Examination of a 32-year old woman who has pain in her shoulder as a result of a head-on motor vehicle accident reveals tenderness directly over the scapula and painful motion of the shoulder. Radiographs show a displaced extra-articular fracture of the scapula. Which of the following studies would best detect commonly associated injuries?

The gluteus maximus is innervated by which of the following nerves?

A 20-year-old professional baseball pitcher has had a 3-year history of increased aching in his shoulder that is associated with pitching, and he is now seeking a second opinion. Nonsurgical management consisting of rest, anti-inflammatory drugs, ice, heat, and cortisone injections has failed to provide relief. A previous work-up that included radiographs and gadolinium-enhanced MRI arthrography was negative. Results of an arteriogram suggest quadrilateral space syndrome. Assuming that this is the correct diagnosis, what nerve needs to be decompressed?

• A 55 year-old man has multiple lytic lesions in the humeri, clavicles, and scapulae. Which of the following diagnostic studies best confirms a diagnosis of multiple myeloma?

A 45-year-old previously healthy woman has experienced weakness and fatigability for 2 months. She states she feels best in the morning, but tires easily with exertion. If she sits and rests her strength improves, but she easily tires with each activity. When her fatigue is most severe, she has double vision. Physical examination is positive for ptosis with upward gaze after 20 seconds. When she holds her arms out straight she shows good initial strength, but rapidly decreasing strength with time. What is the pathologic cause of her muscle weakness? Review Topic

A 45-year-old woman sustains an injury to her lower leg. Examination reveals that there is a deformity with no neurologic or vascular problems. The skin is intact. Radiographs are shown in Figures 46a and 46b. Which of the following factors would make closed management the least appropriate choice for this injury?

An 18-year-old man has had an enlarging mass in his hand for the past 3 months. Radiographs, an MRI scan, and biopsy specimens are shown in Figures 54a through 54d. What is the most likely diagnosis?

Which of the following findings helps to distinguish between stress fractures of the tibia and shin splints? Review Topic

A 51-year-old woman is seen for evaluation of chronic supraspinatus and infraspinatus tendon tears. Three years ago, in an attempted repair the surgeon was unable to repair the supraspinatus and infraspinatus tendon tears. Currently she has a marked amount of pain, reduced range of motion, and weakness. Examination reveals anterosuperior escape. Radiographs show no signs of arthritic changes. You are considering a latissimus dorsi tendon transfer. During the discussion, you mention that

Figure A shows the 2 bundles of the ACL dissected from a cadaveric knee off their bony attachments. They are labeled Bundle A and Bundle B, respectively. Which of the following is true? Review Topic

A 48-year-old woman has an open subtrochanteric femur fracture. No other injuries are reported. After thorough evaluation, it is determined that she will need emergent surgical fixation. The patient and family indicate that they are practicing Jehovah's witnesses and desire adherence to the religious standards with respect to blood product usage. The patient signs a valid advanced directive confirming these wishes. Which of the following would be considered acceptable treatment?

Which of the following is considered the most effective means of identifying an evolving motor tract injury during cervical spine surgery? Review Topic

A 59-year-old man underwent interposition arthroplasty for osteoarthritis of the elbow 9 years ago. Over the past year the patient has had

A 40-year-old man who is an avid weight lifter has had chronic pain in the proximal anterior shoulder for the past year. He denies any history of trauma. Examination reveals tenderness at the intertubercular groove, a positive speed test, and a positive Neer impingement sign. Nonsurgical management has failed to provide relief, and he is now considering surgery. Arthroscopic findings in the glenohumeral joint are shown in Figure 31. Based on these findings, treatment should consist of

A 54-year-old woman reports worsening pain in her buttock, especially when sitting for long periods of time. She has occasional pain and paresthesias radiating down her posterior leg. She has no significant medical history. MRI scans are shown in Figures 15a and 15b and a biopsy specimen is shown in Figure 15c. What is the most likely diagnosis?

A patient reports persistent anterior shoulder pain following a forceful external rotation injury to the shoulder. An MRI scan is shown in Figure 4. The patient remains symptomatic despite 3 months of nonsurgical management. Treatment should now consist of

The bone avulsion shown in Figure 32 has a high correlation with tearing of the

A 10-year-old boy with severe hemophilia A (factor VIII) sustained an injury to his right forearm 2 hours ago when a classmate fell on his arm during a scuffle. Examination reveals moderate swelling in the forearm, decreased sensation in the distribution of the median and ulnar nerves, and pain on passive extension of the fingers. What is the most appropriate sequence of treatment?

What is the most common benign bone tumor in childhood?

A characteristic genetic translocation has been noted in which of the following tumors?

Which of the following nerves is most commonly injured during ankle arthroscopy?

What is the most important sign of impending modulation with rapid progression of a spinal deformity in neurofibromatosis?

• An otherwise healthy 65-year-old man has had chronic pain in his prosthetic knee for the past 9 months. Repeated aspirations reveal a coagulase-negative staphylococcus infection. To eradicate the infection while maintaining the best possible joint function, management should consist of

What is the most common complication following surgical treatment of a displaced talar neck fracture?

While performing long fusion with osteotomies for a patient with adult scoliosis and sagittal plane deformity, the neurophysiologist reports a change in motor-evoked potentials in the lower extremities. What is the most appropriate next step?

What type of thoracolumbar spinal injury is associated with an increased risk of neurologic deterioration following admission to the hospital?

What is the primary mechanism by which anabolic steroids increase muscle tissue? Review Topic

Figure 43 shows the lateral radiograph of a 12-year-old boy with mild osteogenesis imperfecta who injured his left elbow after pushing his brother. Treatment should consist of

• When taken concomitantly with which of the following, erythromycin can cause an increase in the blood level of

Figure 63 shows the radiographs of a 23-year-old man who sustained a twisting injury at work. Swelling, tenderness, and ecchymosis are noted about the entire midfoot. What associated injury is most likely to be problematic?

If the patient had an isolated spine injury without neurologic deficit, the most appropriate next step would be

An 18-year-old collegiate basketball player has had a 3-month history of activity-related back pain. She describes isolated low back pain without radiation that increases with training and playing basketball. Her pain resolves with rest. Physical therapy for 6 weeks has failed to provide relief. An axial CT scan is shown in Figure 17a, and Figures 17b and 17c show sagittal CT reconstructions through the right and left lumbar facets, respectively. Further management should consist of which of the following?

A 22-year-old skier reports painful range of motion in the left thumb after falling forward on his outstretched hand while holding his ski pole. Examination of the left thumb reveals increased AP laxity and 45° of valgus laxity at the metacarpophalangeal (MCP) joint. Examination of the right thumb shows 25° of valgus laxity at the MCP joint. Radiographs are normal. Management should consist of

Examination of a 5-year-old boy with amyoplasia shows a flexion contracture of 70° of the right knee. The active arc of motion is from 70° to 90°, and the opposite knee has a flexion contracture of 10°. Both hips are dislocated with flexion contractures of 10°, passive hip motion is from 10° to 90° of flexion, and the feet are plantigrade and easily braceable. Despite a daily stretching program, the parents and physical therapists note that it is increasingly difficult for him to walk because of the flexion contracture of the right knee. Management of the knee flexion contracture should now include

A collegiate golfer sustains a hook of the hamate fracture. After 12 weeks of splinting and therapy, the hand is still symptomatic. What is the most appropriate management to allow return to competitive activity?

A 25-year-old male presents to the emergency department with a mangled lower extremity that is not salvageable. He undergoes transfemoral amputation. Three months later the patient presents to the office with the limb sitting in an abducted position. What important step was forgotten during the amputation?

A 21-year-old man sustains multiple gunshot wounds to his right upper extremity. He can not extend his digits or his thumb but can extend and radially deviate his wrist. An injury to the radial nerve or one of its branches has most likely occurred at which of the following locations?

A 50-year-old woman with a 2-part surgical neck proximal humerus fracture and metaphyseal comminution

After humeral head replacement for four-part fractures, what is the most commonly reported difficulty?

Which of the following findings is most prognostic for the ability of a young child with cerebral palsy to walk? Review Topic

A 15-year-old boy reports leg pain after being tackled during football practice. Radiographs and a CT scan are shown in Figures 46a through 46c. The patient has a pathologic fracture through what underlying lesion?

Deep posterior compartment

A 52-year-old woman with a 2-year history of a flexible (stage II) adult-acquired flatfoot deformity has failed to respond to nonsurgical management consisting of immobilization, custom orthotics, nonsteroidal anti-inflammatory drugs, and physical therapy. The patient is unable to perform a single limb heel rise. Weight-bearing radiographs are shown in Figures 30a through 30c. What is the most appropriate surgical correction?

In either a ceramic-on-highly-cross-linked polyethylene (HXPE) or metal-on-HXPE component, increasing the ball head size leads to

The CT scan shows the involvement area is approximately 30% of the posterior facet. What is the most appropriate treatment?

A 25-year-old man shot himself at the base of the right index finger while cleaning his handgun. Examination reveals that the finger is cool and cyanotic. A clinical photograph and radiograph are shown in Figures 44a and 44b. What is the recommended treatment?

A patient who underwent a L4-L5 hemilaminotomy and partial diskectomy for radiculopathy 8 weeks ago now reports increasing low back pain without neurologic symptoms. A sagittal T 2 -weighted MRI scan is shown in Figure 13a, and a contrast enhanced T 1 -weighted MRI scan is shown in Figure 13b. What is the most appropriate management for the patient’s symptoms?

A 56-year-old man underwent right total shoulder arthroplasty 2 months ago. Recently while reaching with his shoulder in a flexed and adducted position, he noted shoulder pain and afterwards he could not externally rotate his arm. An axillary radiograph is shown in Figure 30. What is the most likely cause of this problem?

Of the following clinical situations, which is most likely to lead to osteonecrosis associated with a slipped capital femoral epiphysis (SCFE)?

A 49-year-old male presents with right shoulder pain and weakness after undergoing open cervical lymph node biopsy approximately one year ago. A pertinent finding from the physical exam is seen in Figure A, with the patients arms by his side. Physical exam finding with the arms in a position of 90 degrees of forward elevation and 10 degrees of external rotation are shown in Figure B. What nerve is most likely injured? Review Topic

When comparing the overall outcomes of surgical versus nonsurgical treatment of stable thoracolumbar burst fractures in patients without neurologic injury, 5 years following injury, the principle differences lie in

Figure A is a glenoid CT 3D reconstruction of a 26-year-old accountant who has recurrent shoulder instability. His first dislocation occurred after a fall while skiing. He has now sustained his third dislocation, which was reduced in the emergency department prior to being sent to your office. What is the most appropriate definitive treatment? Review Topic

Figures 1 and 2 display the radiographs obtained from a woman who had volar plating of the distal radius 8 months earlier. Two days ago, she noticed she could not actively extend her thumb. What is the most appropriate treatment that would restore active thumb extension?

Which of the following radiographic parameters is most predictive of a poor result following multilevel fusion surgery for adult degenerative scoliosis? Review Topic

-Figures a through c are the MRI scans of a 21-year-old woman with recurrent shoulder instability and pain after an open anterior stabilization procedure. Positive belly-press test findings were positive.At surgery she was found to have an irreparable tear of the tendon injury identified preoperatively. The procedure to address the dynamic stabilizer deficit places which nerve at most risk?

The load versus deformation curve of the functional spinal unit (FSU) is made up of the neutral zone, the elastic zone, and the plastic zone. What is the plastic zone of the curve believed to represent?

Six months later, the patient’s fracture has healed and a CT scan to further evaluate the physis is performed (Video 85). Based on these findings, how should you advise the family?

The dorsal (Thompson) approach to the proximal forearm uses which of the following intermuscular intervals?

The clinical photograph in Figure 27 shows a palsy of what nerve/associated muscle?

Two major pharmacologic classes of bisphosphonates exist: nitrogen-containing and non-nitrogen-containing compounds. The nitrogen-containing compounds work by which of the following actions?

Haversian canals are found in the center of an osteon in compact bone. They contain blood vessels and nerves.

open biopsy and plating

A 45-year-old right-hand dominant woman falls onto an outstretched left hand. Imaging shows a complex elbow dislocation. The postreduction CT scan demonstrates a reduced joint, comminuted radial head fracture, and type I coronoid fracture. Surgical intervention is recommended to address the involved structures. Which component of the intervention adds the most rotational stability?

A 14-year-old boy has a midshaft fibular lesion. Biopsy results are consistent with Ewing’s sarcoma. Following induction chemotherapy, local control typically consists of

The flap shown in the clinical photograph seen in Figure 51 is based on what arterial supply?

A researcher experimenting with limb patterning removes some tissue from 1 part of the limb bud (which we shall call Site A) and transplants it along the anteroposterior (AP) axis to create a mirror-hand duplication. Which of the following is true?

A 44-year-old patient who has had a proximal first metatarsal osteotomy has recurrent pain and difficulty wearing many types of shoes. Radiographs show a large 1-2 intermetatarsal angle (IMA).

A 51-year-old man sustained an open fracture of his tibia in Korea 42 years ago. An infection developed and it was resolved with surgical treatment. For the past 6 months, an ulcer with mild drainage has developed over the medial tibia. The ulcer is small and there is minimal erythema at the ulcer site. A radiograph and MRI scan are shown in Figures 43a and Figure 43b. Initial cultures show Staphylococcus aureus susceptible to the most appropriate antibiotics. Laboratory studies show an erythrocyte sedimentation rate of 70 mm/h. What is the most appropriate surgical treatment at this time? Review Topic

A 25-year-old semiprofessional football player sustains a hyperextension injury to the left foot. He is unable to bear weight. Examination reveals tenderness along the midfoot with swelling and plantar ecchymosis. Radiographs are negative. What is the next step in evaluation of this patient?

• A 16-year-old girl who swims on her high school team reports pain in the shoulder after swimming. History reveals a glenohumeral dislocation at age 14 years while doing the backstroke. Examination shows a positive anterior apprehension sign. Treatment at this time should consist of

When the data are normally distributed, what statistical test is best used to compare means of three or more independent groups?

Figure 14 shows the AP radiograph of a patient who underwent prosthetic arthroplasty 8 years ago and has now become symptomatic again over the past 18 months. A WBC count and erythrocyte sedimentation rate are within normal limits, and aspiration of the glenohumeral joint yields a negative Gram stain and cultures. Which of the following procedures will most likely provide the best pain relief and function?

When a patient has recurrent anterior shoulder instability, a bony glenoid reconstructive procedure should be considered in which clinical setting?

Figures 23a and 23b show the radiograph and clinical photograph of a patient who reports a reduced ability to flex the interphalangeal joint of her great toe after undergoing a Chevron-Akin bunionectomy. What is the most likely cause?

A 47-year-old woman falls and sustains a direct blow to her middle finger. She notes pain and swelling and is unable to move the proximal interphalangeal (PIP) or distal interphalangeal (DIP) joints. Radiographs are shown in Figures 8a through 8c. Proper management should consist of

Which of the following structures is at risk during proximal dissection of a single lateral perifibular approach for compartment syndrome of the leg?

A 28-year-old man has left knee pain after a snow skiing accident. The MRI scan shown in Figure 47 reveals which of the following? Review Topic

When comparing arthroscopic lavage and knee debridement with placebo in patients with chronic symptomatic osteoarthritis, what outcome has been demonstrated?

A direct lateral (Hardinge) approach is used during total hip arthroplasty. The structure labeled A in Figure 7 is the

A 45-year-old man reports severe discomfort following a twisting injury to his right ankle and foot. Plain radiographs are negative; however, the CT scans shown in Figures 39a and 39b reveal a fracture. Management should consist of

-Where is the physis with the highest growth rate (in mm per year) located?

What molecules have been shown to promote fibrosis during muscle injury?

Which of the following therapies has a direct anabolic effect on bone?

Recurrence of this deformity after initial treatment should be treated with

A 22-year-old woman has had progressive upper extremity weakness for the past several years. History reveals no pain in her neck or shoulders. Examination reveals scapular winging of both shoulders and weakness in external rotation. She can abduct to only 120 degrees bilaterally, and there is mild supraspinatus weakness. She is otherwise neurologically intact with normal sensation and reflexes; however, she has difficulty whistling. A clinical photograph is shown in Figure 14. What is the most likely diagnosis?

A patient who sustained a cerebrovascular accident (CVA) 18 months ago has a long-standing spastic adduction contracture of the shoulder with a rigid block to passive external rotation. Significant hygiene problems exist with maceration and continued skin breakdown. Management should consist of

Figures 29a and 29b show the AP and lateral radiographs of a 30-year-old man who has increasingly worse back pain and stiffness. Examination shows painful, limited spinal range of motion. There is no neurologic deficit. What laboratory study would be most helpful in confirming the diagnosis?

Figures below show the radiographs, MRI, and MR arthrogram obtained from a 25-year-old collegiate soccer player who has new-onset left groin pain. He played competitive soccer from a young age and has competed or practiced 5 to 6 times per week since the age of 10. He denies any specific hip injury that necessitated treatment, but his trainer contends that he had a groin pull. He reports groin pain with passive flexion and internal rotation of the left hip, and his hip has less internal rotation than his asymptomatic right hip. He is otherwise healthy. What is the primary cause of a cam deformity?

• Which of the following methods of treatment of a displaced Lisfranc fracture-dislocation will most reliably lead to good functional results?

Figure 56 is the MR image of a 20-year-old Division I baseball pitcher who has a 1-month history of medial elbow pain in his throwing arm. He also notes a decrease in both control and pitching velocity. An examination reveals tenderness at the medial epicondyle that is exacerbated with valgus elbow stress. The strongest indication for ulnar collateral ligament (UCL) reconstruction is